Following an Ulcer Diet

Peptic ulcers are caused by long-term use of certain medications, as well as the bacterium Helicobacter pylori (H. pylori), an infection that requires treatment with antibiotics. However, following an ulcer diet can help reduce the pain and irritation associated with these sores on the lining of the stomach, esophagus, or small intestine.

Some foods, like berries and grapes, help repair damaged tissue. But alcohol and spicy foods, for example, irritate the digestive tract's natural layer of protection and can worsen ulcers.

This article will explain which foods to eat and which to avoid if you have a stomach ulcer.

What Is an Ulcer Diet?

An ulcer diet is an eating plan designed to bring relief from peptic ulcer symptoms, prevent flares, and prevent more ulcers from developing in the future.

It is designed to:

• Correct nutritional deficiencies that contribute to your symptoms
• Provide the protein and other nutrients your body needs to heal
• Help you avoid foods that irritate the ulcer
• Help with related conditions like Crohn's disease, celiac disease, or bacterial infections

An ulcer diet should be followed along with any other treatment recommendations from your healthcare provider.

Many peptic ulcers are caused by long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), which can damage your digestive tract lining. Others are caused by H. pylori. An ulcer diet adds foods with antibacterial effects and compounds that boost healing in both cases.

A 2021 review of medicinal plants published in the Journal of Drug Delivery & Therapeutics looked at a range of natural remedies including polyphenols. Polyphenols are a type of antioxidant found in many plant foods that can be used to manage peptic ulcers.

Some polyphenols help to heal stomach lining ulcers faster, while others have antibacterial effects and help kill H. pylori. Polyphenols in green tea may calm inflammation and help strengthen the tissue that lines the stomach.

Foods to Eat and Avoid When You Have an Ulcer

Best Choices

Fruits: Any fresh or frozen fruits contain helpful fiber and antioxidants. Berries, apples, grapes, and pomegranates are among the best choices for healing polyphenols. If citrus fruits or juices like orange or grapefruit trigger reflux, avoid them.

Vegetables: Leafy greens, bright red and orange vegetables, and cruciferous vegetables (like broccoli, cauliflower, and kale) are packed with vitamins and antioxidants that are especially good for your overall health and healing. Avoid spicy peppers and tomatoes, or products made with them if they give you reflux. Limit raw vegetables because they are harder to digest.

Lean proteins: Skinless poultry, lean beef like sirloin or tenderloin, fish, eggs, tofu, tempeh, dry beans, and peas are excellent sources of low-fat protein. Fatty fish like salmon, mackerel, and sardines provide omega-3 fats, which can reduce inflammation and may be helpful in preventing another ulcer.

Fermented dairy: Products like kefir and Greek yogurt provide probiotics (helpful bacteria) along with protein, so they're good choices.

Breads and grains: Whole grain breads, and whole or cracked grains like oats, quinoa, farro, millet, or sorghum are good sources of fiber to include in your diet.

Herbs and spices: Hot, spicy foods are usually avoided on an ulcer diet, but a review of studies on food and H. pylori found that some spices added for flavor also help kill the bacteria. You can freely use most mild herbs and spices because they're sources of antioxidants. Best bets include turmeric, cinnamon, ginger, and garlic, which have antimicrobial and anti-inflammatory properties.

What to Avoid

Alcohol: All alcohol is a stomach irritant and will delay healing. Avoid wine, beer, and spirits.

Caffeine: Cut back or stop drinking coffee, tea, and caffeinated sodas. They can increase stomach acid production.

Milk: There was a time when milk was used in treating ulcers, but research has found that it increases stomach acid. It's best to avoid it.

Certain meats: Skip any highly seasoned meats, lunch meats, sausages, and fried or fatty meats and proteins.

High-fat foods: Try to avoid large amounts of added fats, which can increase stomach acid and trigger reflux. You may need to avoid gravy, cream soups, and salad dressings, but healthy fats on the list are OK.

Spicy foods: Consider skipping anything that is "hot," such as chili peppers, horseradish, black pepper, and sauces and condiments that contain them.

Salty foods: Researchers have found that salty foods may promote the growth of H. pylori. Pickles, olives, and other brined or fermented vegetables are high in salt and linked to a higher risk of H. pylori ulcers.

Chocolate: Chocolate can increase stomach acid production, and some people find that it triggers reflux symptoms.

How the Ulcer Diet Works

An ulcer diet promotes healing and reduces irritation to the stomach lining and the duodenum, the first part of the small intestine that attaches to the stomach. It also limits excess acid production, which can aggravate an ulcer.

There are no strict rules about which foods to eat, but try to add as many foods as you can from the list above. Avoid foods that make you feel worse or that trigger acid production and reflux.

Eating enough protein is also important. While your ulcer is healing, aim for about 1.2 grams of protein per kilogram of your body weight. That means about 3 ounces of lean poultry or meat per day for a 140-pound person assigned female at birth, and 4 ounces per day for a 200-pound person assigned male at birth.

The rest of your calories should come from a balanced diet that includes whole grains, fruits, and vegetables. More fiber may lower the risk of ulcers, but one Korean study found that high-fiber diets lowered the risk of peptic ulcer disease in women but not men. It's a good idea to ask your healthcare provider about fiber intake.

Duration

You should stay on an ulcer diet until your healthcare provider tells you your ulcer is completely healed, and then go back to your normal way of eating.

But if you feel better while on the diet or you have risk factors for ulcers, like smoking, this way of eating may be worth continuing—even if in a modified way.

Recommended Timing

Try to eat five or six small meals each day, rather than three large ones. Stomach acid is produced every time you eat, but large meals require much more of it for digestion, which can be irritating.

Finish eating at least three hours before bedtime, and try to stay upright for a few hours after your last bite for improved digestion and less acid reflux.

Cooking Tips

Stick to lower-fat cooking methods like roasting, braising, and grilling instead of frying. Also, limit your use of butter and oils when you cook, as these can be harder to digest.

Modifying an Ulcer Diet

In some cases, ulcers occur when you have celiac disease or inflammatory bowel diseases. Make sure to stay on any special diet you use to manage those conditions while you're following the ulcer diet.

For celiac disease, that means avoiding grains with gluten, such as wheat, rye, and barley, and taking care to read food labels for sources of hidden gluten.

For inflammatory bowel diseases, this may mean avoiding the milk sugars in lactose-based foods, staying away from carbonated beverages, and choosing lower-fiber foods. Limiting seeds, nuts, beans, and some fruits, and following a low FODMAPS diet is also helpful.

Considerations

Other factors may come into play when using the ulcer diet, and they could affect your overall health.

General Nutrition

An ulcer diet should not harm your complete nutritional status. As long as you maintain good variety in your diet, you can still get the nutrients you need from other foods when you stop eating the ones that irritate your ulcer.

If you're trying to add more polyphenol-rich foods and fiber to your diet, and you cut back on fatty foods, an ulcer diet may be even more nutritious than your regular diet.

Practicality

It should be fairly easy to stick with an ulcer diet when you're preparing your own meals at home. It may be harder to stay on track when you're traveling, attending parties, or celebrating holidays. If you can't pass up that glass of wine or piece of chocolate cake, make it a small one.

Energy and Health

With fast food, chips, and alcohol off-limits, you might find that you're eating healthier, feeling better, and maybe even dropping some weight.

Summary

Foods by themselves don't cause stomach ulcers, and there is more than one possible reason why you may have them. The foods you choose, though, can make a big difference in how you feel and how quickly they heal.

Medical treatment with antibiotics may be necessary if you have H pylori, the bacterium responsible for some ulcer, but an ulcer diet offers options to improve your overall health and nutrition while reducing your ulcer risk.